So there I was relaxing with my gf while watching the French edition of GBO, Le Meilleur Pâtissier, which is just like the British Bake Off, but in French and they focus more on the art of the pâtissier than the baker (for which of course there is a whole other show Le Meilleur Boulanger).

Anyway, with the first challenge out of the way, where the contestants have to reinvent a French classic such as a Paris Brest or Tarte Tropeziénne, we endured an overly stuffed commercial break when I saw something that made me almost fall out of my fauteuil with surprise.

It was an advert from an ISP, but not any ordinary ISP and at first I had to take it with a suitably large dose of salt. The Swiss ISP, Salt, were advertising, on primetime TV, consumer internet services for just under 50 of those strange Euro things a month and for that you got a whole pile of content, an AppleTV box and speeds of 10Gbps.

Yes, you read that right. 10Gbps. 10,000Mbps. Symmetrical - the same speed upload and download.

If you’re the type of person that reacts to this by saying “Zut alors! No one needs 10Gig speeds”, then stop reading now. If on the other hand you reacted by saying “ohlàlà, c’est fantastique!” then stay engaged.

Coppersaurus

In the UK, our average broadband speed has increased over the years and is now clocking in at a wheezing 46.2Mbps download and an even feebler 6.2Mbps upload and the industry and regulator are patting themselves on their backs. Well, almost all the industry. CityFibre, a fibre optic network infrastructure provider is taking the ASA to court as the ASA allow the likes of BT and Virgin Media to promote their electrical and copper-networks as optical fibre ones.

Analogies are always tricky, but here’s one that works reasonably well. Both are cars, but no one would be allowed to claim the Ford Model T is a modern electric supercar such as a Tesla.

Spot the difference. Both are cars, both have 4 wheels. But their performance isn’t comparable.

Gee, that’s fast

Most broadband networks in the UK reach our houses with copper wire and the signalling that’s used over the copper wire is good old-fashioned electric. Electrical signalling over copper wire. That’s what Mr Alexander Graham Bell did 150 or so years ago.

Electrical signals in broadband networks have become much more sophisticated, and the latest version is called G.Fast, which you can read all about here. Suffice to say, G.Fast suffers the same fundamental laws of physics problem that all alternating current over copper wire does: impedance. The speed decreases with distance. In G:Fast’s case, this happens over very short distances - 300m or so and it starts to run out of puff.

Being optimistic

In the beginning there was ADSL broadband. Then ADSL 2+. Then “Superfast” VDSL broadband, which being electrical and based on copper wires, being asymmetrical, being slow, and being unpredictable, is neither super nor fast.

Then along comes “Ultrafast”.

Cool.

Ultrafast broadband uses some or no copper wire in service delivery. It all depends on where you live. If you’re lucky, you’ll be in an area where the type of broadband network available uses just optical fibres, and you’ll be the lucky recipient of 314Mbps download and 49Mbps upload speeds.

If you’re not quite as lucky, you might get similar speeds from an Ultrafast service, but it’ll be delivered on copper wires with G.Fast electrical signalling. While this isn’t all that fast, it’s better than most copper-wire plus electrical signalling services and comes with a 100Mbps money-back guarantee.

I can see what BT is doing here. Their network has some fibre to the home (FTTH) but it’s mostly copper wires carrying electrical signals to the home. Their fibre optic network infrastructure uses an architecture and “passive” technology called GPON. GPON delivers asymmetric services at approx 300Mbps download and 30Mbps upload. By using G.Fast on copper wires where they don’t have GPON-based optical services, they can claim a larger service footprint, and service parity between the electrical and optical.

But the short range of G.Fast means it’s not available to many people, and the only way of guaranteeing 100Mbps is to limit the length of the copper wire - so reaching even fewer people. This is of no help at all in rural areas, where houses can be Kilometres away from the nearest street cabinet.

The G:Fast effect. Its limited reach (300m) is even more limited if you impose a speed guarantee

The xDSL effect. The reach is Kilometres, but the speeds are lower. Even so the reach isn’t far enough. My Dad lives 15 miles from central London and never gets into double digit download speeds.

I know this looks like 1970s wallpaper, but it represents the result of the laws of physics electrical signalling over copper wires has on the delivery of broadband services, and explains why the speed you get is a post code lottery. Each street cabinet is a hotspot that rapidly cools, as impedance degrades the electrical signal, and hence the speed. G.Fast exacerbates this issue, which doesn’t happen with laser light through glass fibres. At least not over the short distances for broadband, even in the remotest parts of the UK. Not to scale obviously.

Coaxing things along

Virgin Media, the rebranded remains of the failed NTL, also uses an electrical network, but with copper coax cable that has a different signalling system from that found on electric plus copper wire networks. This signalling system is called DOCSIS and the next version is mooted to reach 1000Mbps, but whether Virgin plan to roll this out is a moot point.

The 10Gig gig

New service providers, or those with a more ambitious, adventurous strategy, or those unencumbered with a legacy copper network, or with a more innovative investment plan, use a different network architecture and technology for their ”pure” fibre optic network - they have no copper wires at all.

This different architecture combined with the inherent imperviousness to distance (laser light through optical fibres is after all used for trans-ocean networks, connecting continents), means they are able to consistently deliver astonishingly high speeds. In the 90s I had a spirited conversation with a senior executive of France Telecom, who maintained that a speed of 256Kbps would be fine. These days, the “gold standard” of domestic pure fibre optic networks is 1,000Mbps symmetrical, or 1Gig as we like to say in the industry.

But the next step up in this particular architecture is 10 times as fast, in both directions - a full 10,000Mbps. And we’re starting to see these services emerging. And that’s what I saw being advertised in prime time Swiss French TV.

The high (speed) life

What does a 10Gbps service look like? Well, one way to describe this is to compare download (or upload) times. Here’s what Salt say about their 10Gbps service:

It’s all download from here…

Another way of looking at it is as a “graph”. I’ve updated the original version of this to include 10Gbps services and to also reflect today’s service speeds in the UK, download is green, upload is red, 1 vertical pixel = 1Mbps. You might need to zoom out to see it all.

There really is no comparison. My suggestion to the ASA is that if a network can’t do 1000Mbps (1Gbps), with an easy upgrade to 10Gbps, then it’s not pure fibre optic broadband, which is of course le meilleur réseau.

It’s coming up to the anniversary of my brain surgery, which you can read about here

Subsequent to all that, I had the chaos-causing cancerous kidney removed shortly before Christmas 2017. The tumour there was less than 1 cubic millimetre in size. Yes, you read that right. 1 cubic millimetre.

To keep things under control I’m on some medication, which is pretty amazing stuff. Sutent forms part of my daily life now. I take it in blocks of four weeks, with two week holiday between each four week period.

As you may know, cancer is an out-of-control growth of cells. Healthy cells have an off-switch, they stop dividing. Cancerous ones do not. As far as I understand it, Sutent put back the off-switch, resulting in no new thing arising. And where there is a cluster of cells, a tumour, this can only continue to survive if it taps into a blood supply. Sutent also disrupts this, depriving the tumour of oxygen, so it withers and dies.

There are side effects - I might go blonde, which I’m quite looking forward to, but I suspect this is simply a polite way of saying grey. There are other issues, but I’ll leave it up to you to google them - if you’ve got any questions I’ll do my best to answer them if you PM me.

Fireside chats…

Going to the Churchill hospital in Oxford for checkups and scans has now become a routine, and I have fantastic support from my employer. Once a quarter I have scans and slightly more frequently we visit the town of dreaming spires for a cosy fireside chat, I leave a sample of blood behind then we go for coffee and cake in one of any number of pleasant eateries before getting back on one of GWR’s delayed trains to eventually get home again.

While I’m indebted to the NHS and the amazing medical staff at the John Radcliffe and the Churchill hospitals, I’m pretty sure there’s a more efficient way of running this treatment. For example, if there’s no need for me to physically be there, such as for a scan or blood test, then why do we have to take up pretty much a whole day for a fifteen minute chat?

I questioned one of the senior staff members of the oncology team, and it seems to come down to two factors: funding and assessment. The clinic gets funding for each physical visit, so there’s financial aspect to this way of working. If they change to a visit-less system, they lose the funding, so there’s little incentive to change, to innovate. Also, the consultant explained, they like to see patients’ reactions to diagnoses, test results and other feedback from the medical staff, and to generally assess how their patients are doing.

My diagnosis

Whether I have a consultation in one of their offices, or a consultation by Facetime, it’s still 15 minutes of the medical staff’s time. So I don’t get the financial argument. It doesn’t add up.

I can see there’s some merit in their being able to see facial expressions and reactions to what can be distressing news. And by the same token I can understand there is a need medically to eyeball patients to assess how the patient is coping with ongoing treatments, some of which have far tougher regimes than mine.

But the fact is that technology now out-performs the human eye. Smartphone cameras are so sensitive, they can detect medical conditions that are simply invisible to the human eye. With a Facetime or similar video call, the medical staff would not only get to see the happy smiling faces of their patients, but would also be able to diagnose, non-invasively and passively, their patients’ physical condition in a way that is impossible in a face-to-face meeting.

If I need to provide a blood sample, why can’t this be done at my local Doctor’s surgery?

Happy SnappySnaps

Here are some examples of the state of the art:

Biliscreen

“A new app could lead to earlier detection of pancreatic cancer simply by snapping a smartphone selfie. The disease kills 90 percent of patients within five years, in part because there are no telltale symptoms or non-invasive screening tools to catch a tumour before it spreads. BiliScreen provides estimates of bilirubin levels in a person's blood. Elevated levels can be an early warning sign for pancreatic cancer, hepatitis and other diseases.”

“Now MIT Media Lab spinout Cardiio has developed a mobile app that uses a smartphone camera to detect facial signs of a heart arrhythmia associated with strokes. It does so by measuring and analysing minute changes of light reflected on the skin as the result of the underlying pulse.”

Smartphones are yesterday’s news

Clever and wonderful all of that is, there is a different, newer, product category that has the potential to outdo even the smartest of smartphones for medical diagnoses and monitoring: the smartwatch.

I can only really talk about my experience of the AppleWatch, but I understand other smartwatches are available.

I was not originally a fan of the AppleWatch. I thought it was important for Apple to launch a new product category after the death of Steve Jobs, and the AppleWatch was nice enough in its way, but .. meh.

However thanks to the generosity of a friend, I was gifted an Apple Watch 3 for Christmas. The first thing we did with it was to was to make a Dick Tracy-style wristwatch telephone call…

The second thing I did with it was to start to track my physical activity - and I’ve become a devotee of “completing my rings”. Having always had good health and having the good fortune to do pretty much any physical activity I wanted to do, last year’s escapade showed how precarious we can all be. Despite physically recovering in leaps and bounds, a year later I’m still not quite back to where I was, but I figure the more I do, the more I’ll be able to do, and the fitter I am I’ll be better able to withstand whatever comes next.

The AppleWatch works in conjunction with a couple of iPhone apps, one that tracks activity, the other health. So I’m not rock climbing again yet, but normally I cycle 5Km a day during the working week, sometimes more at a weekend, and walk about 10Km a day. Here’s yesterday’s (a Saturday) activity:

Let’s get Sirious

The Health app though is the really interesting one. The AppleWatch does many splendid things and one of these is that it measures resting pulse rate, which it records in the Health app on the iPhone. Here’s mine for the year so far:

Guess when I started taking Sutent! You can see the 4 week on 2 week off cycle reflected in the peaks and troughs of my pulse rate.

I showed this to one of the medical staff at Hôtel de Churchill who said “Aha - one of the side effects of Sutent is a reduction of thyroid activity, which results in decreased pulse rate, we’ll test your bloods for this”.. and lo and behold, I have an under active thyroid and will soon add more pills to my pharmucopia (like a cornucopia, but of pills, not corn).

AppleWatch to the fore

So I’ve become a convert to the AppleWatch and to wearable devices in general.

The AppleWatch 4, launched last week does, as Apple would say, take wearables “to the next level”, a marketing term I’ve always hated but in this instance it is entirely justifiable.

AppleWatch 4 can not only detect falls and automatically phone your contacts and the emergency services for help, it can produce FDA-approved electrocardiograms (ECGs) which can be output as a regular PDF for sharing with your clinician. This is, according to Apple, the first over-the-counter device to do this, and it’s breathtaking in its implications, and is a signpost as to where this technology is going.

My prognosis

We have an ageing population. We have an obesity problem. Both of these are placing additional stresses and strains on an already under-funded, under-supported, under-resourced, under-valued (I’m entitled to my opinion) health service. The advances in cancer treatment are astonishing, but “biological innovation” takes a long time and costs a fortune. The Sutent I take is amazing, but it’s a one-size-fits-all shotgun. Imagine a customised laser-beam version that’s specifically formulated for me, so the side-effects are minimised if not eliminated. We are years away from such drugs.

Technological innovation proceeds at pace and the humble cell phone has become a smart health device. The smartwatch significantly augments the smartphone and the two together are a killer combination… OK so maybe that’s not the best term to use, but you get what I mean.

On the basis that prevention is better, easier, cheaper than the cure, maybe in the not too far distant future we’ll all be wearing smart health devices, and really transform health care in the UK.

07:30 Friday 15.9.2017

The third vomit was messy. I missed the bowl and dribbly puke ended up on the floor.

But at least the honey I’d put into the porridge meant the vile bitter taste had been ameliorated somewhat.

I lay back down on the wooden floor of the hallway, contemplating my situation with some bemusement and puzzlement.

I didn’t feel in any imminent danger, but certainly didn’t feel like standing up. The headache, my constant morning companion for the last few weeks, was insistent. But I was fully cognisant.

Discussed options with 111. My new reality was that my world comprised a small patch of wooden flooring from which I really didn’t feel like moving. I’m not even sure I could have, even if I’d wanted to.

I dialled 999.

———

The paramedics were professional. Precise. Polite. Efficient. Vital signs all checked out; they used a nearby standard lamp to rig up an IV paracetamol feed to bring near instant relief for the headache, and decided I needed hospital. A hasty kiss with my partner and I made it into the ambulance.

———

The Doctor shut the door. That was enough of a sign, a small clue, another adjustment to a new reality. I knew the news would be bad, but it wasn’t conclusive. They needed more tests to be certain of diagnosis, so I needed to be in a different hospital, where the specialists were.

There was no point in asking the ultimate question “How long have I got?”, as they simply didn’t have enough information.

Blue-lighted in an ambulance across three counties to arrive at the John Radcliffe at midnight. The expected scenes of high impact action from ER didn’t happen. Instead.. calm. Quiet. Surreal after that pellmell dash.

———

I look at my roommates and think I’m lucky. There are three others in the ward. Tracheostomies and colostomy bags. Infinitely tender care from the staff, carefully shaving their stubble, but barely a reaction from them to their carers’ ministrations.

The next day my much relieved but still anxious girlfriend visits, which was lovely. I haven’t told Mum and Dad yet as there’s too much unknown, not enough certainty, too much doubt. What could I say? They’d only worry.

The unexpected pause over the weekend brought me to a low on Sunday night, simply because I knew the medics didn’t know what was what. The waiting, the not knowing, the doubt all leads to fear for the future.

I needed a plan.

———

Monday morning hustle and bustle, the hospital has come alive. More scans and tests rapidly ensue. The tuna in my head has been matched to one on a kidney. This is good news. Primary on the kidney, secondary in the head. I can live with that. It could have been far worse. Seems like organ cancers like to migrate to the head. Head cancers don’t migrate to the body’s organs.

An interesting choice of words “Based on the evidence, this is what we believe”. No guarantees.

———

I have an outline plan, enough to make the call, enough to clearly explain my new reality. This has happened, this is what’s going to happen. It’s all under control. Until this is all sorted, this will be my world.

Mum and Dad took it well. After that it was easy to tell everyone else.

There are a lot of tick boxes, lots of luck. The headaches in my head were caused by a build up of pressure as brain fluid wasn’t draining, due to the tuna partially blocking a drainage ventricle. Steroids rapidly brought that under control, the medical staff relaxed.

I relaxed.

I was moved to a luxurious single occupancy room, with ensuite facilities.

I relaxed some more.

Three times a day I get my vital signs checked - everything’s fine. I’m fit. I’m healthy, “a teenager’s blood pressure”, flattery will get you everywhere my dear. I just have a couple of inconvenient lumps. The question they need to answer is, what’s the detailed plan of action going to be? There are lots of choices, lots of options, all with consequences. But we do now have time on our side, there’s no grave imminent danger, no need for a “smash & grab raid”, as one nurse described it.

In the meantime, would I like a cup of tea? And a biscuit?

———

The meals are fine. They are plentiful and nutritious. And free. But they are uniformly bland in flavour and texture, which of course suits many of my fellow patients. My usual and preferred diet is fresh salad, fish, veg, fruit.. I decide to eat mostly in the Prêt à Manger café downstairs. Something to look forward to in the monotony of waiting (and because I’m a food snob…)

Meat and two veg - not really my cup of tea

Besides, although I have the now mandatory DVT socks, I need to be mobile, active, and take a promenade up and down the main stairs, about eight flights from top to bottom, half a dozen times while listening to the BBCR4 Today show, then porridge with banana and honey for breakfast, with a decent flat white and a slice of normality, away from the incessant bleeps and chimes of vital signs.

My gym...

———

Here at the John Radcliffe, 3’s cellular network sucks, and I’m barely able to maintain a connection for a conversation. It’s so bad, even texts sometimes don’t go. More often than not I have to walk down a couple of corridors to a private interview room on the edge of the building where the network is a bit stronger to make a call, I simply can’t do this from the comfort and convenience of my own bed. I’m happy I can walk, many others here can’t.

There’s a sketchy unsecured WIFI hospital hotspot. And BT charge a tenner a day. That would have cost me about £180, and it’s not even that good (I measured it - see below). Fortunately I can log in for free. Had I had to pay for that, then my blood pressure results would have been off the charts. There are plenty of people here for whom £10 a day is simply far too expensive, out of reach.

BT’s exorbitantly-priced “premium” hospital WiFi service isn’t even that good

It’s a shame the same can’t be said of the telecoms industry, who should adopt a user or patient-centric approach to determine needs and deliver on that, rather than provide the bare minimum functionality their technology choices can provide, and deliver a sub-standard service at a price many can’t afford. I wonder who the product manager is for this service and wonder how they can defend it.

———

Two cancers. Two different locations. Three different teams. Lots of options. Discuss.

———

Wait. Wait. Wait….

To keep me amused and occupied, I finished a blog entry about WiFi and published it on LinkedInhere.

I’m sorry I’m not a Dr, I’m a patient trying to escape.

———

I’ve had an idea.

So - you’re in hospital and want to keep in touch with friends, family and loved ones. Worry is the enemy. Worry is caused by not knowing. Carefree communication is key.

Download an app.

On my wrists, I have two scannable NHS wristbands with all the relevant ID on - MRN number, bar and QR codes etc.

I use the app to scan the wristband bar codes so the app recognises I’m a patient. Maybe it cross references to an NHS database to double check validity of patient status. I could maybe supplement this with manual input of NI number.

It’s geofenced to the hospital.

The effect is to remove any tariff limitations from your regular monthly cell phone tariff - minutes, data, TXTs. It overrides whatever you have with unlimited everything, AND gets you on to a decent 802.11ac 5Ghz FREE WiFi connection.

Carefree communication all the while you need it, so your family and friends can keep in touch. There’s nothing worse than saying to your Mum “The operation’s going to be on…” and the signal drops out. It is in fact, fucking unacceptable.

When you leave the hospital geofence, your original tariff resumes.

This does of course pre-suppose the hospital is flooded with suitable telecoms infrastructure.

Friday 29.9.1017: 04:15.

Choices are: radiate or operate?

Radiotherapy is less disruptive, but causes swelling and the little shit inside my head has taken up all the spare room anyway. There’s no space left for it to expand into. So it needs to be made smaller and the only way to do that is to go in with a manual intervention and perform a full or partial excision.

It’s right in the middle of my head, on top of my brain stem, 4cm in from the back of my skull, which is now covered with Matrix-style plastic discs.

Back of the head selfie... Remember the truth: there is no cancer.

I’m in the queue, nil by mouth since midnight, waiting to go for surgery. Feels very lonely.

———

Wheeled into the anaesthetics room, the team introduces themselves, tubes all plugged in, coloured scans are on screens, I start to feel… odd.

And blink.

———

You know those fisheye camera shots, where the person in the foreground has a much larger head than everyone else? That’s the first thing I saw when I opened my eyes a fraction of a second later, with what seemed like the entire team peering in at me, the amazing Mr Plaha in the background waved and smiled.

I have it on good authority that my first question was “Where’s my iPhone?”

My first sensation was “Ow! My balls are on fire!”... Did they operate on the correct lumps?

“Here have this, it’s a little treat”.. a largish plastic syringe was emptied into my mouth - flavoured alcohol? Like one of those cheap disgusting super-sweet alco-pops designed to get kids hooked on booze; it turned out to be morphine.

Seemingly it was an eight hour marathon, due to excessive blood. Now I quite like the idea of having lots of blood inside me, the problem is having lots of blood sloshing around a brain. So although a chunk of this tumour’s been taken out, to keep me safe Mr Plaha had to leave more in than he would have ideally liked.

Eight hours on your front causes chaffing, and although they make every effort to alleviate the symptoms, it can’t all be prevented. So burning bollocks, for a short while, is a small price to pay for a successful and skilfully performed operation.

TMI?

There’s more to come. I didn’t read about this stuff in the Macmillan PDF.

———

Transferred to the Intensive Care Unit (ICU). “Coming around” takes a long time and many people experience vomiting. I was pretty hungry having not eaten anything since dinner the previous evening, so ate a Bland & Bland Shepherd’s pie. From about midnight to about 5am, I puked up once an hour, eventually gagging on a thoroughly empty stomach, despite being given maximum doses of anti-nausea drugs. And of course this emptied any pain killing tablets also, so we switched to intravenous paracetamol.

Further shots of morphine seemed to aggravate the puking, and didn’t dull the headache, which surprised me as I had the impression it was a pain panacea. But then it turns out there are different types of pain…

———

Two of the dearest people in my world came over for visiting, but I wasn’t really communicative for most of Saturday, being totally wiped out. Boring for them but I was hugely grateful they’d made the effort to sit by and take care. I could at least listen to them burbling away in the background.

Started to perk up towards the end of the day, managed to eat a couple of small cartons of ice cream, the instant sugar hit being part of my biological reboot.

Later that evening I was back in a four person room on the Neurology ward.

———

Sunday they started to clean me up, removing unnecessary cannulas. Some years ago I did the MCA Ships’ Captains’ Medical Certificate, and part of this involved learning how to insert catheters, using prosthetics. This time around I was out for the count when mine went in, but I was certainly awake when it came out and it feels - odd, a very strange sensation indeed. Not painful, but uncomfortable and peeing afterwards is a sensitive affair and guys, you’ll probably want to sit down for the first 20 or so pees as you’re not really sure what’s going on down there.

I’d had a bed bath and was sat in a chair reading a book when my girlfriend arrived, which cheered her up no end.

Later managed to walk unaided to the loo, 5 yards away.

New reality, new expectations, little victories. Take what you can.

———

Another Monday MRI scan. Was able to get to the Prêt à Manger café for a coffee, using the lifts.

New reality, new expectations, little victories…

Everything’s settling down. Still taking paracetamol tablets and steroids, and seemingly the entire hospital supply of laxative. Constipation is almost inevitable, with the drugs and general inactivity, so get used to some discomfort.

The scans checks out OK and rumours start I’ll be let out later in the day, but in the end we play the cautious card, so here I remain in the tender care of Hotel JR for a while longer. Which is fine with me.

———

Wed 4.10.17 16:30

“Home, home again, I like to be here when I can. When I come home cold and tired, it’s good to warm my bones beside the fire”

Incredibly, less than a week after pretty intensive brain surgery, I’m back home, and very relieved to be here too. While I have received extraordinary levels of care and attention, and hospitals are great places for treatment, it seems to me that they are less good for recovery and rest. They are necessarily industrialised places, and care comes first, so those long steroid-induced insomniacal nights are punctuated by bleeps and whirrs of monitoring devices, central corridor lighting bleeds into the bedrooms, and occasionally a really serious-sounding alarm has to be responded to so there’s a general rushing whoosh as a nursing team rapidly reacts… there’s little opportunity to get uninterrupted rest.

And of course hospitals are full of ill people and the chance of infection is high.

It is though with some sense of trepidation that I prepare to leave. Although I haven’t been here that long, it’s still been nearly three weeks and it feels safe inside. I have begun to feel institutionalised. Outside feels unsafe, insecure. As I wander around the hospital in my regulation green pyjamas and especially with my post-op dressing on the back of my head, I identify as a patient. I’m one of us, someone special. That identity starts to disappear as I change back into civvies for the first time in nearly a month.

On the left: My Punk dressing, stapled neatly into place. C’est brutal, mais ça marche... On the right: A week later the dressing came off. My medical team is delighted with the quality and rapidity of the healing process. I need to keep an eye out for any weeping of clear fluid, as this could be a sign of infection, which could result in nasty complications…

My brother arrives, collects up my bags and I bid a fond and thankful farewell to as many of the fabulous staff as I can.

———

We patients chat - swap stories. We’re all here to recover, we each have our own stories to tell. Tragic. Inspirational. Reassuring. I think we are seeking reassurance. But a couple came in and it sounded like he was going to have pretty much the same treatment as I’d had. While I couldn’t say “This will happen to you too”, I could say “This has been my experience, and it’s been OK”… I’m talking, living, breathing proof that the system can work. She seemed relieved.

Hope it helped - but I never saw them again.

———

On visiting hours.

Visiting hours are not really there for visitors. They are really there to provide an exclusion zone so that the medical staff can focus on the daily round of treatment of their patients.

There is precious little privacy in a ward, it is inevitable that as a patient you will hear if not see very intimate details about your fellow ward members. It’s quite one thing to share these details with the nurses and doctors looking after you, it’s another to share intentionally or otherwise with other patients.

But to my mind there is a common bond, an unspoken understanding that what happens in a ward, what is shared in a ward, stays in the ward.

If your loved ones, friends, family, rock up early or linger late, they intrude into this intimate, caring world. Sharing intimate health issues with completely random strangers is quite a different experience from sharing with trusted medical staff, or with other ward members. It’s frankly none of their business, and they have no business being there.

In any case, the medical staff are intensely busy during the morning - the night staff have to complete all the medical checks on all their patients, they have to hand over to the day care team, who then also have to complete their checks and prepare their charges for the day ahead.

I was lucky, I could pretty much look after myself, shower, toilet unassisted. Others though needed help shaving, needed mechanical hoists to get them out of bed and into wheelchairs, needed catheter reservoirs emptying and changing and so on.

In my view it’s inappropriate for friends and relations to gatecrash all this, becoming an intrusive nuisance, for no real benefit to anyone except their selfish selves.

So help your hard-pressed medical team to better look after you, respect your patient peers, and insist on prompt visiting time keeping from your folk.

Thank you.

———

Friday 13.10.2017

Two weeks ago today, I had an eight hour operation on my brain.

Today I had two and a half hours of meetings at my new client’s premises in central London, spending time with the team and starting get under the hood of what they are about.

Go figure.

———

On steroids.

These tiny wee pills have helped save my life, so thanks very much. But there’s no such thing as a free lunch and the side effects I’ve experienced are: lack of tiredness - getting 3 hours sleep in 24 and not being tired isn’t much fun. Weight gain as I seem to be constantly hungry - even recognising I’m feeding the steroids and not the body doesn’t seem to help much. Constipation. Lack of libido - ‘nuff sed. Taste - my mouth seems to be permanently lined with a weird-tasting layer which interferes with flavour. Nothing other than tea seems to even temporarily cut through this, and I don’t even like tea. Constantly thirsty, despite all the tea.

Ugh.

———

I have (had):

Two cancers - one primary, the other secondary

Two locations - head and kidney

Three teams - head surgery, head radiotherapy, kidney extraction

Two specialist nursing teams - head and kidney

Two hospitals - John Radcliffe (head surgery) and the Churchill (head radiotherapy and kidney extraction)

A single point of contact would be most useful as I tend to get conflicting messages about meetings and treatments from time to time.

———

27.10.17 Four weeks after brain surgery and six weeks since ambulance paramedics arrived at my house…

The particular form of radiotherapy I’m having is called stereotactic radiotherapy. Part of the process involves making a customised thermoplastic mask and helmet combo, which in my case was made a couple of weeks ago, and into which my head has now been snapped into position.

Part of its function is to hold my head absolutely still, as the room-sized microwave has sub-millimetre accuracy, and the last thing the team needs is for my head to bobble about a bit, ruining the physicist’s previous two weeks of planning the best angle of attack on the remains of this wretched tuna in my head.

As mentioned, it’s in quite deep, sitting on top of my brain stem, being fed by a blood vessel, and there’s a lot of brain structure to get through, ideally with minimum collateral damage.

If you’ve ever had an MRI scan, then it’s not really comparable, as you’re not inside a tunnel, you’re not inside the machine. Here I’m lying on a similar table or platform, looking through the plastic mesh facia of my mask, and can see a large disc three feet away from me. There’s a red LED glow diffusing through the mask’s plastic lattice.

The staff, having settled me in as comfortably as possible, are talking numbers, presumably 3D coordinates. For form’s sake, an alarm sounds as they leave the room for their radiation-proofed control centre. They have a Spotify playlist running, some soft rock indie band, which is quite pleasant, really. The machine whirrs and bleeps - the large disc moves in an arc around my head, first to the right, then to the left, the LED glow goes green. The platform I’m lying on rotates also, so they can bake each part of the tuna…

..and within 20 mins it’s all over. The mask is removed and I’m free to get up and leave.

There’s no sensation of anything happening inside my head - the brain isn’t equipped with pain-sensing nerves in the same way as hand and fingers. I guess evolution never expected the deep insides of our brains to be prodded and probed in this way.

I get a cup of tea from the café and jump into the cab for the ride home. Only four more blasts, one every other day, and this phase of my treatment will be concluded. Hopefully.

The man in the white plastic mask

———

My cornucopia of chemical compounds... left to right...

Anti-sickness pills to overcome the effects of radiotherapy

Stomach protector to overcome the effect of the steroids

Steroids to overcome the swelling of the tuna and brain caused by radiotherapy

Paracetamol to overcome any discomfort or headaches

Laxido (the clue as to what this does is in the name) to overcome the effect on digestion of all the other drugs…

———

10.11.2017 - delay and disappointment

Here we press the pause button.

The kidney team advise that they don’t yet have enough information about what’s going on inside my body to make the decision about the optimum treatment that will incur minimum risk with maximum benefit, the best outcome.

Despite very strongly suggesting previously that removing the kidney, while being a major intervention and trauma to the body, was their preferred approach, their revised view is that there is no evidence that the risk of this intervention at the moment is required or necessary.

So the plan now is to let everything settle down, take a more cautious approach, and in three month’s time assess once again after a load more scans and tests.

So I’m living with an alien inside of me, which from one perspective is in itself a risk - all the drama I’ve been through so far has been caused by this kidney cancer spreading itself to my head, and all the while it’s still there, the risk of this repeating, or something similar happening, is there. On the other hand, the kidney cancer was probably there certainly for many months if not years before part of it broke off and migrated north.

The difference now though is that I know it’s there - sometimes I feel like I can feel it.

However, the medical teams deal with all this on a regular basis, I am not unusual, not the first and sadly not the last either. Their expertise, skill and professionalism has got me to where I am now, which is pretty damn amazing. No one’s expecting any major incident to happen, I can carry on as normal.

So the new reality I’m adjusting to today is different from the one I was expecting yesterday, and the new reality has plenty of great things in store.

———

I cannot speak highly enough of the NHS. From the moment I pressed the last 9 of 999 only six weeks ago through to now, the care and attention I have received has been exemplary, extraordinary. The original paramedics made the right call to get me in for a scan. The local hospital made the right call to get me into the John Radcliffe, probably the best place in the country if not the world for this kind of thing.

The brain surgery team there, lead by Mister Plaha. made the right call on the treatment, which despite be very high risk, was performed flawlessly, professionally, with astonishing results.

For those of us in the telecommunications industry this may sound like a startling question. However it is a genuine question from a member of the public that took part in a discussion about broadband and how it was being marketed.

For those of you that might be reading this that also don’t know the answer, no - Wi-Fi doesn’t come from satellites.

Wi-Fi is a wireless technology developed for Local Area Networks, and uses standards defined by the IEEE, in this case a bunch of standards under the exotically titled 802.11 banner. Wi-Fi can travel a few metres, it certainly won’t reach satellites.

And it doesn’t get you to the internet either, which is another common misconception.

To get from a Wi-Fi router or hotspot to the internet, that router or hotspot needs a “backhaul” network to get you to the internet. From home, this would be your broadband connection and everything that goes on beyond there to connect all the way through to the Netflix servers.

Wi-Fi has become a near-ubiquitous and very convenient networking technology, an incredibly successful communications innovation. How many of us get irritated when we can’t get on-line, from a train for example or in some instances even hotels? We even expect it for free and when presented with a payment login wall for a Wi-Fi service, I for one will switch my iPhone’s hotspot feature on and use that for practically free.

The rise of Wi-Fi has led directly to the café culture style of working - park up in your favourite espresso joint, order a donut, and hit those emails on the device of your choice.

Fantastic.

And we all have Wi-Fi in our homes too, where there are unintended consequences for the apparent performance of your service. Wi-Fi has many strengths but it also has weaknesses too, and I think you need to be aware of these weaknesses, as you might be blaming your service provider for poor broadband speed (and that’s all to easy to do) when in fact the problem lies closer to home. In your home, in fact.

Ironically, as broadband speeds increase, and super low latency “ultra-fast” 1000Mbps services become more prevalent, the impact of Wi-Fi performance becomes more of an issue. The unpredictable and variable nature of slow-speed highly contended copper broadband, masks Wi-Fi issues. In fact, the two can often combine to create a perfect storm of poor service performance.

Electromagnetic Krispy Kreme donuts

The usual practice of internet service providers when they install your router is to use a short, maybe 2m, cable inside your house so your Wi-Fi equipped router is neatly nestled against a wall.

It’s convenient for them for the install, but perhaps less so for you. The reason for this potential inconvenience is that the shape of the Wi-Fi signal is like a donut - think invisible electromagnetic Krispy Kreme Original Glazed - it’s a toroid. Technically speaking it’s omnidirectional - it’s the same in all directions (or almost all directions) which is exactly the characteristics you need for flooding a room or house equally with Wi-Fi from a single point, so everyone gets the same signal.

Sadly it’s not as simple as that.

As your newly installed Wi-Fi router is likely to be next to an external wall, and the shape of the Wi-Fi signal is to all intents and purposes a sphere, this means much of your Wi-Fi signal disappears out of your house.

And that’s not all, but to explain the next bit, I’m going to have to talk technology. A bit.

a, b, g, n, ac

I mentioned the IEEE earlier - the Institute of Electrical and Electronic Engineers (although it’s not the Engineers that are electronic or electrical as far as I know). As I said, this august body sets standards for many things including Wi-Fi so that we can easily connect our laptops and iPads to routers.

But standards don’t stand still - they are constantly evolving. So in the consumer space over the last 15 or so years we’ve had a veritable variety comprising 802.11a, 802.11b, 802.11g, 802.11n and the very latest and exciting 802.11ac.

Wi-Fi is a radio signal and just like regular entertainment radio stations such as BBC’s Radio 4, it uses specific frequencies or frequency bands as part of the standard. The latest hotshot hotspot standard on the market and being heavily promoted, 802.11ac, was released in Dec 2013 and uses 5Ghz frequency, but to keep it “backward compatible” with non-ac devices, it also supports the older 2.4Ghz frequencies from earlier Wi-Fi standards.

Naturally, to take advantage of this, your end device needs to support the same standard. An 802.11g device might well use an ac Wi-Fi router, but it won’t use the 5Ghz frequency.

Why is this important?

2.4Ghz is a busy place - it’s a common frequency frequently used by many other things such as bluetooth devices and baby monitors… so there’s a lot of interference through which your laptop has to punch to get to the router and vice versa. All this interference degrades the signal strength and this will cause a reduction in the streamed data rate of your internet connection.

5Ghz is a less-used frequency and is therefore subject to less interference. It’s also faster, so it supports a faster streamed data rate then 2.4Ghz. Those pesky laws of physics though mean that although 5Ghz frequency is faster, it’s strength deteriorates over a shorter distance, it doesn’t go as far. it also doesn’t have so much “penetration” power as 2.4Ghz, so those handy walls you have in your house might be bad news for 5Ghz Wi-Fi.

On the other hand, 2.4Ghz punches through walls, so for some types of property, your neighbour’s Wi-Fi might be interfering with yours! Whereas the shorter range 5Ghz option may avoid this issue.

Crossing the channel

Within the frequency bands (5Ghz, 2.4Ghz) are various numbers of discrete channels. If two end devices (PCs for example) are using the same channel, this this can cause interference and spoil your Game of Thrones experience. This is why when you phone up your service provider to complain their broadband isn’t working, they often ask you to change Wi-Fi channels, or they might do it for you remotely.

5Ghz has more non-overlapping channels than the 2.4Ghz band, so again there’s less likelihood of interference which results in a better service experience.

Map your Wi-Fi

Wouldn’t it be great if you could actually see what your Wi-Fi network looked like, so you could find out how to optimise the location of your router to get the best possible coverage? Well the great news is you can.

There are a number of different tools you can use to do this. I used a combination of an augmented reality iPad app from Stanley tools to draw a plan of my house. I then exported that into a MacOS application called Netspot to measure and plot the Signal to Noise Ratio of my Wi-Fi radio network.

The more Signal to Noise, the better, the more Noise to Signal, the worse.

Here’s the resultant Wi-Fi map:

Test point 7 was right above the Wi-Fi router, which was on a desk in the dining room, tethered to the VirginMedia network access box by a 2m cable. The graph shows a lot of green - the signal - and not much pink - the underlying noise. It's a strong Signal to Noise Ratio (SNR).

An Ookla speedtest at this point showed I had 205.96Mbps download speed and 7.72Mbps upload speed. This kind of asymmetry is a common characteristic of copper-based broadband, albeit in VirginMedia’s case where they have their own network, they use copper coax cable instead of copper wires.

Test point 1 was a few metres away in the kitchen. Here you can see much less green signal, and although the pink noise has remained much the same level as it was in the dining room, the ratio between the two is vastly different. The Ookla speed test in the kitchen shows the impact this reduced Signal to Noise Ratio has on service speed.

You can't change the laws of physics so what can you do about this?

One simple thing you can do is to move your router into the centre of your house. I did this by buying a 10m coax cable extension from Maplins, and used that to reposition my router on top of (but not inside) a cupboard so it was higher up and more central. This had an amazing effect on Wi-Fi coverage in my humble abode.

Make sure your router uses both 5Ghz and 2.4Ghz frequencies - upgrade to 802.11ac! A recent trend has been to present these two frequencies to the end user as one Wi-Fi network option on your Wi-Fi network picker on your laptop, and it automatically serves up the better of the two signals to you. 802.11ac also sports such exotic technologies as “beam forming” and “MIMO” (Multi In Multi Out) aerials. MIMO is usually either 3 x MIMO or 4 x MIMO, and promoted in such a way to give the impression that 4 x is better than 3 x. But it does depend on the capabilities of your device, so upgrade your devices too.

For folk with large houses, or old houses with thick walls, one Wi-Fi source may simply not be enough to provide adequate universal coverage. My parents purchased a pair of “Powerline Adaptors” which simply plug into the mains sockets and uses the electrical wiring to transmit the signal to a corresponding Powerline Adaptor in another room, effectively extending the Wi-Fi range. There are limitations to this though, as Powerline Adaptors need to be on the same ring main.

You can add Wireless Access Points (WAPs), which is relatively simple to do, or even build what’s known as a “full mesh” Wi-Fi network, which is at the bleeding edge of Home Area Networking.

Or you could simply connect your devices using good old fashioned Ethernet cables. But these may not go very well with your soft furnishings.

Conclusion

It’s very easy to pin immediate blame on your ISP for buffering and stuttering issues, especially given the wobbly nature of copper-based broadband. But it might be worthwhile ensuring you have the best Wi-Fi set up possible before once again calling your ISP for support. And should you be fortunate enough to be able to take a real fibre optic broadband service, then take it as this will dramatically improve your whole internet experience.

Maybe it’s because it’s the 20th anniversary of the publishing of the first Harry Potter book, but whatever the reason there seems to be a lot of magic in the air at the moment. Both the Tories and Labour have their own magic money trees and Ed Vaizey seems to have been hit with a Broadbandius Confundus curse whereby he believes the simple act of choosing “superfast broadband” will magically deliver superfast speeds.

As Hermione Granger will tell you without dashing off to the library to look it up, the effects of the Broadbandius Confundus curse is to forget all about the laws of physics we mere muggles have to contend with, and that 10Mbps download speed and 2Mbps upload speed is sufficient to squeeze our daily digital lives through.

Hogwarts students who study the effects of curses and spells on the non-wizarding world should study the effects of this common curse by watching this video:

Fortunately, there is a counter-spell which makes you almost impervious to the effects of the Broadbandius Confundus curse. It comprises reading and understanding twenty simple points, so simple that even Crabb and Goyle are reputed to have fully understood them:

“Superfast broadband” is a made-up term by BT’s marketing team. It doesn’t really exist.

What it comprises is a bunch of technologies, running signaling systems (variants of the DSL family) over copper wire

Copper wire is a good conductor of electrical signals, but it also has intrinsic resistivity to these electrical signals

These signals are alternating current, so the type of resistivity involved is called impedance

It is impedance that causes most of the loss of signal strength with distance - the longer the copper wire, the weaker the signal gets and the slower your broadband. The number of people signing up for the service is nothing to do with it

So Ed Vaizey is correct in that anyone can sign-up to the service, however this does not mean they’ll get “superfast’ speeds. In fact there is nothing super or fast about superfast broadband

Indeed if, like my Dad, you’re at the end of a long piece of copper wire, you will not get “superfast broadband” - the most he gets is about 6Mbps download and 2Mbps upload. Yet he’s CHOSEN, as Ed puts it, to sign up for superfast broadband - it’s those pesky laws of muggle physics getting in the way

Dad lives in Surrey. 15 miles way from Diagon Alley, central London, in case you’re wondering

Where they don’t have their own network, VirginMedia resells BT’s services - as do a lot of broadband suppliers - so often it’s the same stuff, with a different brand...

Virgin’s own network uses a different signaling system (DOCSIS) over a different type of copper wire - in this case it’s “COAX cable”, the type of cable you use to connect an aerial to a TV. Unlike with BT, no one else gets to sell this service, they don’t have what the industry calls a “wholesale” option

The mix of DOCSIS and copper coax cable is slightly better at handling high electrical frequencies, so it provides faster broadband than BT’s set up, and Virgin have been doing some smart things in their network to further boost their broadband speeds (port bonding). But even Virgin are tying themselves up in knots as on their posters they talk about fibre optic broadband and show a picture of a copper coax cable

Neither of these systems (BT’s copper wire + xDSL and Virgin’s copper coax cable + DOCSIS) is FIBRE OPTIC broadband because they both use copper wires to connect to our houses

This make a huge difference as laser light through fibres obey different laws of muggle physics from electrical signals over copper wire - even a few feet of copper makes a massive difference

Laser light through fibre is to all intents and purposes impervious to distance - at least as far as the distance to connect houses to a telecoms network is concerned - it is after all used for trans-ocean undersea cables

Because of this, a real fibre optic network (or pure fibre or full fibre) is a much fairer network - and this is the really important thing – as if by magic everyone receives pretty much the same speed irrespective of where they live - up a mountain or in the middle of London

A side effect, and a very welcome side effect, is that the right kind of fibre optic network can deliver 1000Mbps symmetrical (upload and download) or MORE (10Gbps for example). If it were a broomstick, it would be a Nimbus 2001, as compared to Ed’s Cleansweep 1.

Why is this important - because it’s a higher quality service - try downloading a Mac or Windows system upgrade (4GB or more) on a feeble 10Mbps service and see how you get on, or when working from home taking part in a multi-party Skype call on a 1Mbps uplink

It’s for these reasons that copper-based broadband services should not be promoted as “fibre optic”, as it’s a) incorrect and b) misleading

But not all fibre optic networks are the same. In the UK, Gigaclear, Hyperoptic, B4RN are among the very few that can deliver 1000Mbps (1Gbps) symmetrical services today. Where BT do provide real fibre optic services, which is as rare as a unicorn, they provide up to 300Mbps down and 30Mbps up

We have to have a Brexit angle on this - the FTTH (Fibre To The Home) Council of Europe publish stats of each member state’s fibre optic broadband penetration - remember this is where the optical fibres terminate at the house and there’s no copper used - guess which country isn’t even on the charts? Now that we’re leaving the EU, and our soon-to-be-former-partners are zooming away with REAL fibre optic broadband, we’ll be left in the uncompetitive copper slow lane… unless you live within reach of the service providers I mentioned earlier

So there you have it. The counter-spell to Broadbandius Confundus curse which disillusions those affected so that they see copper broadband for what it is: